Use of Ethylene Vinyl Copolymer for Embolization Outside the Central Nervous System: A Case Review

Onyx (ethylene vinyl copolymer; Medtronic, Minneapolis, MN) is a nonadhesive, nonabsorbable, permanent liquid embolic agent. It is Food and Drug Administration (FDA) approved for preoperative embolization of brain arteriovenous malformations (AVMs). Onyx is composed of an ethylene vinyl alcohol (EVOH) copolymer, dimethyl sulfoxide (DMSO), and micronized tantalum powder. Each substance plays a vital part in the overall effectiveness and delivery at embolization. EVOH is the embolic component and DMSO facilitates delivery through the catheter by acting as a solvent. Micronized tantalum powder allows radiographic visualization. Onyx is available in two concentrations: Onyx 18 (6% EVOH) and Onyx 34 (8% EVOH). Onyx 18 has lower viscosity which allows for greater downstream flow from the delivery microcatheter.

Onyx has been used off-label in a variety of applications outside the central nervous system. It was effective in treatment of hemorrhagic complications from uterine AVMs with a success rate of 92%.[1] In a single center review, Onyx had an 89% clinical success rate in a variety of conditions, including aortic stent graft endoleaks, peripheral AVMs, and hemorrhage.[2] Mahdjoub et al reported 100% efficacy in treating renal hemorrhage in 24 patients.[3] Mozes et al reported successful treatment of type II endoleaks in aortic stent grafts in 72% of patients.[4]

Though effective outside the central nervous system, in the experiences above, Onyx does have limitations. It is more expensive than many other embolic agents. Prior to use, Onyx must be shaken for 20 minutes, a consideration which may limit its utility acutely with planning on its use.[4]

The goal of this case review is to describe the use of Onyx outside the central nervous system in a variety of clinical scenarios including patient instability, coagulopathy, or failure of other embolic agents.

Publikationsverlauf

Artikel online veröffentlicht:
16. Juni 2023

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